PATIENT PRIORITIES CARE: THE PAST, THE PRESENT, AND THE FUTURE

Abstract Healthcare based on patient goals can improve the care of older adults, particularly those with MCC. Prior studies have identified five healthcare values that guide how patients establish healthcare goals and make medical decisions: 1) Self-sufficiency, 2) Enjoyment, 3) Connection, 4) Balancing quality and length of life, 5) Engagement in care. The Patient Priorities Care (PPC) approach is an evidence-based approach that allows patients to identify their healthcare values, or what matters most to them, and identify one thing, the most important goal they want to address based on their healthcare preferences. We have demonstrated that PPC is feasible and results in less burdensome care, including fewer medications and referrals to specialists. In the VA system, we have also shown that PPC helps clinicians recommend home and community services that are aligned with the patient’s priorities. To enhance its relevance for Veterans, African Americans, and Hispanics, a deliberate effort to adapt PPC has been used at different institutions. We believe that evidence-based interventions like PPC can help address health disparities by: 1) improving communication between healthcare providers and patients with different beliefs, race, ethnicity, and culture; and 2) aligning prevention and timely treatment with the health priorities of older adults with MCC. We will review what we have learned from PPC thus far. We will then describe current efforts to implement PPC in a more effective and sustainable manner and disseminate it in diverse healthcare systems. Finally, we will share our vision moving forward and opportunities for collaboration and growth.

depending on the quality of the relationship.Cross-sectional and longitudinal studies have shown that loneliness (defined as a subjectively perceived deficiency in a person's social relationship) is more pronounced in low-quality relationships.
Little is known about daily sources of loneliness within a couple.To explore this question, we investigated whether low-quality activities in a partnership can lead to feelings of loneliness in daily situations.To examine this question, we analyzed data from 72 individuals (M age = 43 years, range = 18 -82 years; 64% female) who provided 576 measurement occasions on seven consecutive days in which they were involved in activities with their romantic partners.Participants indicated how they experienced the activity in each situation (positively or negatively) and how lonely they felt.Results showed that participants who reported lowerquality activities with their partner reported higher levels of daily loneliness (47% explained variance); and on occasions when participants reported lower-quality activities than usual, they also reported higher levels of loneliness (25% explained variance).Moreover, individuals who reported higher levels of loneliness during the 7-day assessment benefited less from high-quality activities with their partner in terms of reduced loneliness.Thus, loneliness not only results from, but also contributes to, how people experience daily activities with their partners.Gender and age had no effect on these associations, suggesting generalizability of the results.

OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS FROM VULNERABLE POPULATIONS: THE SUCCESS OF PATIENT PRIORITIES CARE
Chair: Rafael Samper-Ternent Discussant: Lee Jennings As older adults in the USA grow more diverse, equitable translation of knowledge and best practices to vulnerable groups is essential.Older adults with multiple chronic conditions (MCC) benefit from care focused on the health priorities of individuals.Health priorities include: 1) core values that provide meaning to life; 2) specific, actionable, and realistic health goals that reflect these values; and 3) care preferences that include what individuals are able and willing to do (or not) to achieve their goals.For vulnerable older adults, adverse life experiences provide context to their values.A diverse panel will review the Patient Priorities Care (PPC) approach and describe how PPC has been successfully adapted at different institutions.The first presentation will describe PPC and the importance of identifying values, goals, and health preferences for older adults with MCC.The presenter will show that PPC improves outcomes among older adults, their families, and healthcare providers.The second presentation will describe the implementation of PPC in the VA system.The presenter will describe the impact of PPC and efforts to disseminate it.The third and fourth presentations will describe the cultural adaptation of PPC for older African Americans and older Hispanics respectively.The presenters will describe the adaptation process and discuss the barriers they faced, and the lessons learned from each population group.The panel will conclude by providing suggestions on how to disseminate and increase the adoption of PPC to identify what matters most for diverse older adults.

ADAPTATION OF THE PPC APPROACH FOR HISPANIC OLDER ADULTS
Rafael Samper-Ternent 1 , Gilberto Perez 1 , Melissa deCardi Hladek 2 , and Carolina Fonseca 3 , 1. UTHealth Houston,Houston,Texas,United States,2. Johns Hopkins School of Nursing,Baltimore,Maryland,United States,3. Harvard Medical School,Boston,Massachusetts,United Sta tes Older Hispanics have a high prevalence of MCC, contributing to a higher risk for dementia.As a result, there is a rapid increase in the number of young Hispanics assuming caregiver roles.The caregiver role is a cultural expectation among Hispanics and caregiving by the family is preferred over professional caregiving.There is limited information on how the unique context of Hispanics impacts the dyadic interactions between older adults and their care partners.There is a gap in the literature on how health values among Hispanics frame their healthcare goals and preferences and whether care partner involvement impacts the identification of these goals and preferences.There is also a limited number of evidence-based interventions that can help shift the current healthcare paradigm from clinical-guideline-based care to patient-centered care for underrepresented older adults.Thus, we used the Heuristic Framework to culturally adapt PPC for Hispanics with MCC and cognitive impairment living in Texas and embed it in two Geriatrics Clinics.We will describe the adaptation and implementation process and share findings from a pragmatic pilot study with 25 older Hispanics that participated in the PPC approach.We will share the outcomes from this pilot and the feedback received from patients, caregivers, and clinicians on the implementation of PPC at these clinics.We will conclude by sharing the current plans to expand the outreach of PPC for diverse older adult populations.

PATIENT PRIORITIES CARE: THE PAST, THE PRESENT, AND THE FUTURE Aanand Naik, University of Texas Health Science Center at Houston, Houston, Texas, United States
Healthcare based on patient goals can improve the care of older adults, particularly those with MCC.Prior studies have identified five healthcare values that guide how patients establish healthcare goals and make medical decisions: 1) Self-sufficiency, 2) Enjoyment, 3) Connection, 4) Balancing quality and length of life, 5) Engagement in care.The Patient Priorities Care (PPC) approach is an evidence-based approach that allows patients to identify their healthcare values, or what matters most to them, and identify one thing, the most important goal they want to address based on their healthcare preferences.We have demonstrated that PPC is feasible and results in less burdensome care, including fewer medications and referrals to specialists.In the VA system, we have also shown that PPC helps clinicians recommend home and community services that are aligned with the patient's priorities.To enhance its relevance for Veterans, African Americans, and Hispanics, a deliberate effort to adapt PPC has been used at different institutions.We believe that evidence-based interventions like PPC can help address health disparities by: 1) improving communication between healthcare providers and patients with different beliefs, race, ethnicity, and culture; and 2) aligning prevention and timely treatment with the health priorities of older adults with MCC.We will review what we have learned from PPC thus far.We will then describe current efforts to implement PPC in a more effective and sustainable manner and disseminate it in diverse healthcare systems.Finally, we will share our vision moving forward and opportunities for collaboration and growth.

PATIENT PRIORITIES CARE FOR VETERANS Marcia Mecca, VA Connecticut/Yale School of Medicine, West Haven, Connecticut, United States
People receiving care in the Veterans Affairs (VA) health system are older, have greater socioeconomic disadvantage, and more chronic conditions than those receiving healthcare outside of VA.PPC is well-suited for older adults with multiple chronic conditions and aligns with the VA's Whole Health movement.A small VA PPC pilot study demonstrated that those receiving PPC compared to usual care had fewer medications added and more home and community services aligned with priorities.VA primary care is a cornerstone and hub for veteran care utilizing a team-based approach.A two-site randomized controlled trial exploring the implementation of PPC in VA primary care is currently recruiting veterans.The early phase of the project involved semi-structured formative assessment interviews with key stakeholders to obtain feedback and perspectives on PPC implementation in VA primary care.Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis.Concerns elicited were time constraints, follow up and documentation of changes in priorities over time, managing patient expectation, communication between primary care and specialty care, as well as how PPC would impact quality metrics.In response to these findings, the patient priorities note template was shortened and streamlined, and the study communications workflow was adapted to align with clinician preferences.Succinct templated language for care alignment was crafted and shared with study providers.Education for clinicians highlighted ways in which priorities could be used to optimize communication.Study procedures were added to identify quality metric exclusions.The study will explore how PPC impacts veteran care and experience.

FORMATIVE EVALUATION TRIAL OF THE "MY HEALTH PRIORITIES" PROGRAM IN SOUTHERN OLDER AFRICAN AMERICANS: THE BHIP STUDY Deborah Ejem, University of Alabama at Birmingham, Birmingham, Alabama, United States
Older African Americans (AA) with multiple chronic conditions (MCCs) living in the Deep South are less likely to have access to early palliative care (PC) despite experiencing higher symptom burden and healthcare use, and poorer communication around goals of care.This disparity in PC use may partly be due to a lack of culturally-responsive care practices that effectively activate AAs with MCCs to identify their own values and priorities for end-of-life care.We conducted a formative evaluation of the web-based, self-directed "My Health Priorities" Identification Program to determine cultural acceptability and feasibility of use among AAs with MCCs in a primary care setting.We are now recruiting 20 AA patient with MCC and caregiver dyads from UAB Kirklin Primary Care Clinic.Recruited dyads will complete the "My Health Priorities" program and participate in semistructured acceptability interviews.Patients and caregivers will also complete pre-and post-test measures of perception of care, treatment burden, shared decision-making, and communication exchange.Preliminary findings from six dyads suggest that the current program lacks spirituality-specific content.Dyads also expressed that the exemplar character included in the program was not relatable or representative.Overall, participants stated that the program was useful in helping them to think about and articulate their healthcare values and priorities.The findings from the research will directly inform a small-scale pilot grant that will assess the acceptability, feasibility, and potential efficacy of a values solicitation and operationalization intervention for AAs with MCCs and caregivers.